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Chemical Peel

Surgery Overview

A chemical peel is a treatment to improve the look of the skin. A chemical is applied to the skin and
allowed to soak in. Over the next 1 to 14 days, depending on how deep the
chemical soaks into the skin, the skin peels off. This process destroys parts
of the skin in a controlled way so that new skin can grow in its place. The
chemicals used are sometimes called exfoliating or wounding agents.

There are different types of chemical peels, based on how deep the chemical
soaks in and what type of chemical is used. Things that may affect
the depth of a peel include the strength of the acid in the peeling agent, the
number of coats that are applied, and the amount of time allowed before the
acid is neutralized. Deeper peels give more dramatic results. But they also have
higher risks, cause more pain, and have a longer healing time. There are three basic
types of peels:

Superficial peels are the mildest type of
chemical peel. They can be used on all skin types. In most cases, they use
liquid containing a mild (dilute) acid, most often glycolic acid. Dry ice
(solid carbon dioxide) is sometimes used.

Medium peels soak deeper into
the skin than superficial peels do. They cause a burn of
the skin. Trichloroacetic acid (TCA) is the main peeling agent used for medium
peels. The peel may also be done in several steps using a different
chemical liquid followed by TCA.

Deep peels soak into several
layers of skin and cause a burn. They are used only
on the face. A chemical called phenol is usually used for a deep peel. Deep
peels may not be used on darker skin types, because they tend to bleach the skin. Even in lighter-skinned people, phenol peels—or any type of
deep resurfacing—may bleach the skin. A deep peel can be done only once in most
cases.

Before the peel

Your doctor can help you decide what depth of peel and what type
of chemical is best for you. This decision is based on your skin type, which areas
you want peeled, what kind of results you want, how much risk you are willing
to take, and other things. A small "test spot" may be peeled to get a better
idea of the results, especially for people who have darker skin.

You will start to prepare your skin 2 to 3 weeks before the peel. You will clean it 2 times a day, apply a special moisturizer
or cream 1 or 2 times a day, and use sunscreen every day. This skin care
routine will help the skin peel more evenly and heal faster after the peel. It may also reduce the chance of infection and other problems, especially uneven
color changes in the skin.

In some cases,
daily use of
tretinoin (Retin-A) is also suggested. This is a medicine you apply to your skin. It is most often used
to treat acne, but it may speed healing after a peel.

For medium and deep peels of the face, you may get a short course of medicine (such as
acyclovir) to prevent viral infection. This is most likely if you have had cold sores before and if the peel will be near the mouth or eyes.

How a superficial peel is done

Right before the peel, the skin is cleaned. The chemical (usually
a liquid or paste) is then applied to the skin with a small brush, gauze, or
cotton-tipped applicators. The chemical is left on the skin for several minutes,
depending on the type of chemical used. Water or alcohol may be used to neutralize the
acid and end the chemical reaction, then the chemical is wiped off. You may feel a little
burning while the chemical is on your skin. A handheld fan can help cool the
skin and relieve any discomfort.

How a medium peel is done

The technique used to do a medium peel is like that used
for a superficial peel, but the chemical may be left on longer. Medium peels are more painful because the
chemicals are stronger and they soak deeper into the skin. You may get a
pain reliever and an oral
sedative to reduce pain and anxiety during the
procedure. Cool compresses and fans can be used to cool the stinging and
burning caused by the chemical. The peel takes about 40 minutes. There is
little or no pain after the peel is finished.

How a deep peel is done

Deep peels take the most time and are the most painful type of
chemical peel. The process for a deep peel using phenol is also more
complex than for other types of peels.

You may get an oral sedative and pain
relievers. This is usually in the form of a shot or intravenous injection. General anesthesia may also be used.

You may be put on a heart monitor and get
intravenous (IV) fluids during the procedure. This is because
phenol is toxic when absorbed into the body in large doses. But these
measures may not be needed if only a single, small area is being
peeled.

After the skin has been thoroughly cleaned, the chemical
will be applied and allowed to soak in. After one area of the face is
treated, there will be a 15-minute break before the next area is treated. This is to
avoid getting too much phenol in your body.

Tape or ointment may be applied to the area after the peel to treat deeper problem areas.
When tape is used, it is removed after 2 days. Ointment is washed off with
water after 24 hours. It is then reapplied as needed.

Depending on how large an area is being treated, the entire
process may take 60 to 90 minutes.

What To Expect After Surgery

The time it takes to heal after a chemical peel depends on what kind of peel
was done and how deep it was. Proper care of the skin
after the peel is very important. This care can speed healing, help results last longer,
prevent infection, and avoid color changes in the treated area caused by sun
exposure. Proper skin care after a peel is very similar to the care used to
prepare for a peel. It most often involves:

Cleaning the skin often. You will use
water or a special wash that your surgeon tells you to use.

Changing the dressing or ointment on the wound (for medium
and deep peels).

Moisturizing the skin daily.

Avoiding
any sun exposure until peeling has stopped and sunscreen can be used. After
peeling has stopped, sunscreen should be used every day. New skin is more
likely to be damaged by the sun.

Some doctors may also suggest using tretinoin cream each night,
usually starting 2 to 3 weeks after the peel.

Superficial peels

Superficial peels are done on an outpatient basis. They don't require
anesthesia, and they cause only slight pain afterward. Most people can go back
to their normal activities right away. The skin heals quickly after a
superficial peel. The skin may turn pink. In most cases, there is only a small amount of peeling. You can use makeup to hide any redness until it fades.

Medium peels

Medium peels are usually done on an outpatient basis. You may
need to take a few days off work to recover. A medium peel causes a
burn of the skin. The skin takes 5 to 7 days to heal to a point
where you can use makeup to hide the redness caused by the peel. There is
little or no pain after the peel. But there may be some swelling, mainly if
the area around the eyes is treated. The skin will turn reddish brown in 2 to 3
days and become crusty. Then the skin will flake and peel over the next few days.

Deep peels

A deep peel causes a deeper burn of the skin. Skin grows back about 10 to 14 days after a deep peel. The skin stays very red for 3 weeks, and up to 2 months for some people. Most people take about 2 weeks off from
work. Complete healing of the skin may take several months.

Oral pain relievers may be given to reduce
pain after the peel.

Some people have severe swelling, mainly
around the eyes. Raising the head may reduce the swelling a bit. Corticosteroids may be used for more severe swelling.

You may
get a short course of antiviral and antibiotic medicines to prevent
infection after the peel.

Proper wound care is extremely important
after a deep peel. This care can speed healing and prevent infection of the wound. You may
be asked to shower several times a day to reduce crusting. And you may have to
go back to the doctor's office often to have the wound cleaned and
checked.

Why It Is Done

Superficial peels are used to improve the
look of pigment changes in the skin, acne scars, mild sun damage, or fine
wrinkles in all skin types. They can be done on the face and on other parts of
the body. A superficial peel may also be used to prepare the skin for a deeper
peel.

Medium peels are used to treat mild to moderate wrinkles,
long-term sun damage, pigment changes, and precancerous lesions of the skin
(usually caused by sun exposure). Medium peels are used most often on the
face.

Deep peels are used to treat severe wrinkles, long-term sun
damage, pronounced pigment changes, and lesions and growths on the skin. They
are done only on the face. Deep peels are not done on darker skin types, because
they bleach the skin.

Chemical peels are sometimes done with dermabrasion or laser
resurfacing for a more dramatic overall effect.

A chemical peel (except for a superficial peel) may not be done if
you have:

Recently used isotretinoin (a
drug used to treat acne).

Had recent surgery or radiation treatment on your face. This can make regrowth of the skin more
difficult.

An
impaired immune system. This can delay healing and
increase the risk of infection and skin color changes after the
peel.

Known allergies to certain medicines.

How Well It Works

The results of a chemical peel depend in part on the depth of the
peel.

A superficial peel may slightly reduce sun damage and signs of aging, but it doesn't remove them. The results may not appear for
some time. And when they do appear, you may only see small changes. You may need to repeat peels to get the effects you want.

A medium peel
can work very well to even out pigment differences and reduce fine
wrinkles and signs of sun damage. You may need to get a second peel after 3 to 6
months to produce the best effect.

A single deep peel removes wrinkles and may tighten the skin. The effects are often dramatic. In general,
a person can't repeat deep phenol peels.

Your skin type, your skin care before and after the peel, the doctor's
level of experience, and your lifestyle after treatment can also affect the
results. Some types of skin problems respond better to a chemical peel than
others. People with lighter skin who limit their sun exposure after the treatment tend to have better results than those who have darker skin and those who
keep spending lots of time in the sun.

Before you decide to have a chemical peel, talk to your doctor
about the kind of results you can expect.

Changes in the color and texture of the skin caused by aging and
sun exposure may still get worse after a chemical peel. Chemical peels are
not a permanent solution for these problems.

Risks

In general, the deeper the peel, the greater the risk of side
effects and problems. Chemical peels can cause:

Redness. Expect some redness of the
skin after a chemical peel. With deeper peels or with certain skin types,
redness can be severe. It may fade within a few weeks, or it may last several
months.

Color changes in the skin. Treated areas may be darker or
lighter than the skin around them.

Crusting and
scaling.

Swelling, mainly around the
eyes.

Scarring.

Allergic reaction to the
chemical.

Infection. People who have a history of herpes outbreaks
seem to be more likely to have an outbreak after a chemical peel.

Increased
sensitivity to sunlight.

Special concerns with deep peels

In rare cases, deep peels using phenol can cause more severe
problems during the treatment, including heart, liver, or kidney
failure.

What To Think About

Expectations

Chemical peels are designed to wound and remove the upper layers
of the skin. You need to prepare yourself for how your skin will look
after the peel and as it heals. You also need to
be prepared to use makeup to blend skin tones between treated and untreated
areas, such as between the face and jawline.

It is important to let your doctor know what you hope to
achieve and that you know what results you can expect. Even
with realistic expectations, you may not see results for several weeks or
months after a chemical peel.

Sun protection

During the early healing period after a chemical peel (before the
skin has finished peeling), you will need to avoid sun exposure. After the skin stops peeling, you will need to wear sunscreen every day. Limit
your time in the sun as much as possible. New skin is more likely to be damaged and change color from sunlight.

Options for skin resurfacing

Chemical peel, dermabrasion, and laser resurfacing are the most
common techniques used to improve the texture and look of the skin.
Although these techniques use different methods, they have almost the same
effect on the skin. They destroy and remove the upper layers of skin to allow
the skin to regrow.

No one technique is better than the others. When
done by an experienced surgeon, laser resurfacing may be slightly more
precise than chemical peeling or dermabrasion. But the choice of technique
is based on the site you want to treat, your skin type and condition, the
doctor's experience, your preferences, and other things. Some people may get
the best results by using more than one technique.

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